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Do financial hardship and social support mediate the effect of unaffordable housing on mental health?

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Abstract

Purpose

Unaffordable housing has a negative impact on mental health; however, little is known about the causal pathways through which it transmits this effect. We examine the role of financial hardship and social support as mediators of this relationship.

Methods

We identified households where housing costs changed from affordable to unaffordable across two waves of the Household, Income and Labour Dynamics in Australia (HILDA) Survey (2014–2015). The sequential causal mediation analysis was used to decompose the total effect of unaffordable housing on mental health into the portion attributable to financial hardship and social support [natural indirect effect (NIE)] and the portion not occurring through measured pathways [natural direct effect (NDE)]. Mental health was measured using the Mental Health Inventory (MHI) and Kessler psychological distress (KPD) scale. Baseline covariates included age, sex, household income, financial hardship, social support, marital status and employment status. Bootstrapping with 1000 replications was used to calculate 95% confidence intervals (CIs). Multiple imputations using chained equations were applied to account for missing data.

Results

Unaffordable housing led to a change in mean mental health score on the MHI scale (− 1.3, 95% CI: − 2.1, − 0.6) and KPDS scale (0.9, 95% CI: 0.4, 1.4). Financial hardship accounted for 54% of the total effect on MHI scale and 53% on KPD scale. Collectively, financial hardship and social support explained 68% of the total effect on MHI scale and 67% on KPD scale, respectively.

Conclusions

In conclusion, the negative mental health effect of unaffordable housing is largely mediated through increased financial hardship.

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Acknowledgements

Rebecca Bentley and Emma Baker are supported by Australian Research Council’s Future Fellowship program (FT150100131 and FT1401100872, respectively). We are grateful to Dr Koen Simons for his statistical guidance on combining estimates from multiple imputation and bootstraps.

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Authors and Affiliations

  1. Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia

    Ankur Singh, Zoe Aitken & Rebecca Bentley

  2. School of Architecture and Built Environment, The University of Adelaide, Adelaide, Australia

    Emma Baker

  3. Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia

    Rebecca Bentley

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  1. Ankur Singh
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Correspondence to Ankur Singh.

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Singh, A., Aitken, Z., Baker, E. et al. Do financial hardship and social support mediate the effect of unaffordable housing on mental health?. Soc Psychiatry Psychiatr Epidemiol 55, 705–713 (2020). https://doi.org/10.1007/s00127-019-01773-z

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  • DOI: https://doi.org/10.1007/s00127-019-01773-z

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